PGY-3 Cardiology
Responsibilities
Cardiology consult team from 7:30 to 4:30 each day. Call every 4h night, cardiology conference during ED conference at 11am (third week of month).
You pick up the consult pager at 7:30 in the am from the post call resident. If they had consults overnight and have not staffed the patient, it is your team’s responsibility to present the patient to Dr. Wang. Every day at 11am you will meet with Dr. Wang to read EKGs in the conference room near the cardiology clinic. You are then encouraged to attend the noon medicine rounds in LL42. You start to round with Dr. Wang at 1PM every day. If you get consults during the day while you are rounding with Dr. Wang, you can staff them with him as you are rounding. During the weekend or nights the cardiology resident on call carries the consult pager. Rounds are not necessary on cardiology consult patients during the weekend if patients are stable.
Call
Every 4th night. Call is scheduled by the chief medicine residents, as are days off. You start call at 4:30 pm (at that time you need to page the A or B cardiology senior and get the admit pager from them.) The A or B cardiology team takes admits during the day until 4:30, if you are on call that day you get the pager and can admit up to 10 patients total. Your interns can admit a max of 5 patients each. You may have one or two interns, they will do the admit orders and the admit H&P. Keep in mind that your interns are admitting during the day and may have already admitted their 5 patients, you still have to admit a maximum of 10 patients by your lonesome!! Example: Intern X admits 3 patients during the day, Intern Y admits 3 patients during the day, after 4:30 that means that each of your interns can admit another 2 patients each (4 patients that you are responsible for) then you can admit up to 6 more patients on your own.
Once you hit your 10 patient max, you don’t necessarily “cap.” If you still have more admits and are overwhelmed-you need to page either the yellow/green/red medicine resident on call (in house) and see if they can help-if they too are overwhelmed with admissions then your next step is to page the chief medicine resident on call and they will help call in the next appropriate resident.
If your sister team senior will not be in the hospital on your post call day-you come in at noon on your call day as you will be expected to stay on your post call day until the work is finished. If your sister team senior will be in the hospital on your post call day –they will finish the post call work on your patients. The patient’s that you admit will go onto your sister team and they will round on them from that point.
Post call during the week, rounds start at 9am. Be sure to have copies of the admit ekg and old ekg. Know the previous cardiology studies performed on the patient. You can get copies of the angiograms from the cath lab during the day, at night you are at mercy of the old records (IRIS of paper charts.) It is your job to prep the intern for the classic cardiology presentation (56 yo M with {without}known hx of CAD who presents with chest pain {sob, chf exac}. Cardiac risk factors are………, EKG and CXR results. Assessment and Plan: NSTEMI/STEMI versus Typical chest pain versus Atypical CP versus Noncardiac chest pain…)
Cardiology Conference
The third Thursday of the month the ekg conference is in LL42 during the ED conference. It is your responsibility to have approx 20 ekg with clinical correlations for the conference. This can be done on power point if you are able to scan the ekgs, otherwise the overhead projections are acceptable. Make certain to check the EKG folder in TCA for interesting ekg that have been collected over the month. This folder is located in the lowest drawer under the ultrasound bins in TCA.
2 weeks of your cards rotation you will be solely in the short stay unit and you have no responsibilities to the consult team that week, however you are encouraged to attend the ekg conference. You will present to cards short stay unit at 7am, have the post call person give you a brief presentation of the patients that are observation patients/short stay patients/patients you think will go home within 24 hours, then they become your patients and you are responsible for getting them the proper tests/discharging them and doing the discharge dictation (all patients need discharge dictation regardless of the time spent in hospital). The post call team must keep at least 5 patients –even if they are perfect for short stay/observation. The reason the post call team must keep at least 5 patients is that the interns and med students still need to get cards experience. If there are no patients to admit, then you are encouraged to watch the stress echos/mibis. Encourage the ED resident to admit to observation status if appropriate-patients can have a strong hx of CAD, but if you think their stay will be less than 24 hours, it is very appropriate for CSSU.